Doctors Miss Some Chemotherapy Side Effects

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Chemotherapy destroys cancer cells because the medicines target rapidly dividing cells. But normal cells in your blood, mouth, intestinal tract, nose, nails, vagina, and hair follicles also divide rapidly. So chemotherapy affects them, too.

The side effects you may have from chemotherapy depend on the regimen you're on, the amount of medicine you're getting, the length of treatment, and your general health. The side effects you have may be different from someone else who is on the same regimen.

While your body is recovering from chemotherapy, other medicines can help ease many of the side effects you have. It’s important to tell your doctor and oncology nurse about any side effects you’re having. You may assume that your doctor will notice that you’re having side effects, but an Italian study suggests that doctors can miss up to half of side effect symptoms.

The study was published in the April 2016 issue of JAMA Oncology. Read the abstract of “Self-evaluation of Adjuvant Chemotherapy-Related Adverse Effects by Patients With Breast Cancer.”

To do the study, the researchers gave side effect questionnaires to 604 women who were having chemotherapy after breast cancer surgery between January 2011 and October 2013. The women ranged in age from 45 to 62 years old.

The women filled out the questionnaires after cycle one and cycle three of chemotherapy. The questionnaires asked about the severity and frequency of specific side effects, including:

  • nausea
  • vomiting
  • constipation
  • loss of appetite
  • taste changes
  • diarrhea
  • fatigue
  • pain
  • neuropathy (pain, numbness, or tingling in the hands and feet)
  • shortness of breath

The researchers collected 596 completed questionnaires after the first cycle of chemotherapy and 581 questionnaires after the third cycle. The researchers compared the results of the questionnaires with the symptoms recorded in the women’s medical records by their doctors.

Overall, the frequency and severity of side effects related to chemotherapy were consistently greater when reported by the women compared to what was recorded by their doctors.

Between cycle one and cycle three of chemotherapy, the women reported:

  • vomiting was less severe
  • diarrhea was less severe and less frequent
  • pain was less severe and less frequent
  • taste changes were more severe and more frequent
  • shortness of breath was more severe and more frequent

In comparison, doctors reported only that shortness of breath had become worse.

In an editorial that accompanied the study, Ethan Basch, M.D., of the Cancer Outcomes Research Program at the Lineberger Comprehensive Cancer Center at the University of North Carolina, said the results suggest that “patient reporting adds valuable information about changes in symptoms over time.”

He continued, “Systematic collection of patient reports improves not only detection of symptoms but also clinical outcomes. Prior research has found that integration of patient-reported outcomes into routine cancer care improves the efficiency of symptom assessment, patient-clinician communication and satisfaction, and symptom control and quality of life, and prevents emergency department visits.”

If you’ll be having chemotherapy after breast cancer surgery, talk to your doctor about the risks and benefits of each regimen you’re considering, as well as your personal risk of serious side effects from each regimen. If you’re currently getting chemotherapy and are having side effects, it’s extremely important that you talk to your doctor about any symptoms that you’re having. You don’t have to suffer -- there are medicines you can take to control almost all of these side effects.

For more information on chemotherapy regimens and side effects, visit the Breastcancer.org Chemotherapy pages.



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